Unfortunately this time of year we have particular vulnerability to sports injuries. Contributing factors include lack of sport specific conditioning and flexibility, nagging injuries, worn or overused equipment, and suboptimal weather/surface conditions.

Now is a great time to rest old injuries. I recommend relative rest until there is no pain with activity, full range of motion and normal strength are achieved, and an eager, committed attitude is regained.

Next, turn attend to early season conditioning. Don’t forget to warm up. Warming up increases blood flow, oxygenation of muscle, mechanical efficiency, range of motion, nerve impulse speed and nerve receptor sensitivity. It also improves mental focus. Start by working large muscle groups then turn attention to more sport specific areas. Consider stretching after a warm up and after activity during cool downs. Stretch gently to the point of tension (not pain) and hold stretches for 15-30 seconds. Don’t bounce into a greater range of motion.

Build gradually into your planned aerobic and strength training regimens. It can take up to 6 weeks to condition soft tissues such as ligaments and tendons to accommodate the rigors of a new activity. This less intense phase is a good time to incorporate proprioceptive challenges to enhance the connection between the musculo-tendenous structures and the central nervous systems balance control center. After this adaptation, you can begin a periodization schedule: think hard, harder, hardest, rest. In the early season 5 % weekly increases in distance and intensity are reasonable.

Did you ever wonder what babies can see?
Newborns are able to recognize faces, large shapes and bright colors. By 4 months of age infants can focus on smaller objects and distinguish colors. In the first 6 months an infant’s eyes begin to work together to perceive 3 dimensional space. By age 1 an infant’s vision is very much like that of an adult.

When is an infant’s eye color established?
The color of a baby’s eyes and change in the first year of life – most rapidly in the first 6 months. By age 1 year eye color is generally well established.

How do I know if my baby is having trouble with their vision?
By 4 months of age infants should be able to follow objects as they move across their field of view and make steady eye contact. Infants less than 4-6 months will occasionally appear to have a lazy eye or look cross-eyed. This should not occur after this age.

If everything looks normal could there still be a problem?
Sometimes infants and toddlers have unequal vision with a strong eye and a weaker eye. If the difference is big enough the brain never develops the processing ability for the weaker eye. This is called amblyopia and is the most common cause of pediatric vision loss.

Can this be identified and treated?
Yes! If caught early in life (before age 5 and the earlier the better) corrective lenses will allow normal brain development. At the Fraser Medical Clinic, we recognize the importance of vision in pediatric care and have invested in Visual Photo-Screening to help us identify common eye problems in problems in infants and toddlers. Screening is as simple and painless as taking a picture.

On average Colorado gets over 500,000 cloud to ground lightning strikes every year and about 10 people die from lightning strikes in Colorado every year. At least half of fatal strikes occur in predictably hazardous settings such as on mountaintops, on large bodies of open water or while standing under a lone tree.

As so many of us here are outdoor enthusiasts who recreate and work in potentially hazardous areas I think it is worthwhile to review a few aspects of lightning safety. Prevention is best: Check the weather and don’t be unwilling to call off a planned activity.

If you hear thunder you could be struck. If you are above tree line find the lowest point of an open area and move there quickly. Move away from any fencing or power lines. Spread out from anyone in your group by 50 feet or more and assume the “lightening position” crouched down on the balls of your feet making as little contact with the ground as possible. Avoid buildings and caves with exposed openings, and avoid water – even puddles and rain run-off. If you are below tree line and can shelter in a cluster of smaller trees this is safer than sheltering under a large lone tree or the taller trees.

NOLS has a great Myth Busting video on lightning safety in the backcountry:

The July issue of the Journal of the American Medical Association has just published new data showing that the rate of stroke, the 4th leading cause of death in the US, has dropped steadily over the last 20 years. A fantastic result validating 2 decades of advancing medical practice!

What reduced the risk of stroke and death from stroke?
Researchers attribute the dramatic results to successful treatment of risk factors such as high cholesterol and hypertension, and a reduction in the number of people who smoke tobacco. The magnitude of benefit was greatest in adults over age 65, where the use of cholesterol lowering medication and blood pressure medication has increased the most. Effects were more modest for middle aged adults, and researchers point out that rising rates of obesity and diabetes in the middle aged population might reverse this trend as we see more obesity in elderly adults.

How big was the effect?
The rate of death from stroke dropped 25% and the number of strokes fell by 20%.

What is my risk of stroke?
A variety of tools have been published allowing patients and physicians to estimate an individual person’s risk of stroke and heart attack. Most of them predict 10 year risk, so the calculators apply best to patients over age 50 where the risk of stroke and heart attack is easier to measure and benefits are more obvious. Click here for one example of a Risk Estimation Calculator.

Putting a variety of hypothetical numbers into the calculator can be a very informative demonstration of the power of controlling blood pressure, treating high cholesterol, or quitting smoking.

Does treating my risk factors before age 50 make a difference?
Even though the risk calculators won’t show such impressive changes when applied to younger patients, we know that early and aggressive treatment of smoking, obesity, hypertension and high cholesterol have a huge impact on health later in life.

The MyLifeCheck campaign from the American Heart and American Stroke association presents what we know about heart attack and stroke risk reduction in younger patients very clearly. Visit their excellent website to learn more.

What can I do now?
The answer is obvious but not necessarily easy: eat well, exercise, and don’t smoke. If you have questions about healthy lifestyle choices, if you need help quitting smoking, or if you are interested in finding out more about your blood pressure and cholesterol numbers, check in with your physician. We would be glad to help!

Medical research is well known to have proven that exercise can improve health by reducing our risk of premature death and death from heart disease. Exercise decreases rates of hypertension, diabetes, osteoporosis and arthritis and can improve our sense of psychological well being . What is less widely appreciated is the compelling evidence that exercise can PREVENT some kinds of cancer.

Is this really a big deal?
The most compelling evidence relates to the reduced risk of developing colon cancer. More than 50 different studies have consistently demonstrated that adults who increase the intensity, frequency or duration of exercise can reduce their risk of developing colon cancer by 30-40% relative to those who are sedentary. According to the American Cancer Society, the lifetime risk of developing colon cancer is about 1 in 20. A 35% reduction in that risk would change the numbers to only 1 in 30. Studies in breast cancer risk reduction (more than 60 so far) are more variable but show 20-80% risk reductions. Current US estimates place a woman’s lifetime risk of developing breast cancer at 1 in 8. If we assume a conservative 30% benefit, this would change the odds to 1 in 18! There are fewer studies but positive results for lung cancer, endometrial cancer, and prostate cancer as well.

How does it work?
Researchers don’t think that people who exercise are just more heath conscious. It seems that exercise changes the way our bodies work and the way our genetic material is expressed or emphasized. Exercise induces changes in hormone metabolism, insulin regulation, and changes the genetic expression of growth factors and immune modulators. The impact of these specific changes on cancer is the subject of ongoing research.

How much exercise is enough?
The studies differ widely in the subject’s frequency, duration and intensity of exercise, so making comparisons is difficult. In some studies more vigorous activity seemed most helpful, and in breast cancer research activity in adolescence seemed particularly helpful, but changes in exercise even after menopause still produced benefits. Exercise helped across all ages, and across all body types as measured by body mass index. It is generally accepted that 30- 60 minutes of moderate to high intensity of physical activity is sufficient to achieve cancer risk reduction. Examples of moderate and vigorous exercise can be found here. If you have questions about your own risk of cancer, cancer screening, or would like to discuss exercise capacity and goals we would be glad to help!

According to the Department of Public Health, the US is experiencing a significant increase in the number of cases of Measles this year with 187 cases reported from 1/1 /2014 to 5/9/2014.

But I thought Measles was eliminated. How is this happening?

Measles has been considered eliminated from the US since 2000, but continues to be a significant public health issue worldwide. The CDC actually estimates that world-wide in 2008 there were a horrifying 450 deaths every day as a result of infection with this vaccine preventable illness. Prior to widespread immunization in the US 3-4 million people were infected and 4-500 died from measles every year. Widespread use of measles vaccine has led to a greater than 99% reduction in measles cases in the United States compared with the pre-vaccine era, and in 2012, only 55 cases of measles were reported in the United States.

The current outbreaks of measles are “imported” from other countries, but transmission occurs in vulnerable populations with outbreaks more likely when infection occurs among groups of people with lower rates of immunity from the disease. For example a single community in Texas with objections to vaccination accounted for 59 of 157 cases reported in 2013. Measles isn’t really “back,” but this hinges on continued widespread public participation in measles vaccination.

The local outbreaks of measles in specific unimmunized populations are an illustration of how vaccination prevents outbreaks and saves lives. When a critical portion of a community or group is immunized against a contagious disease, all members of the community are protected against that disease because there is little opportunity for an outbreak. Even those who are not eligible for vaccines—such as infants, pregnant women, or immunocompromised individuals are protected because the spread of disease is contained. This is known as “herd immunity.”

The proportion of people who need to be vaccinated to achieve herd immunity depends on how contagious an illness is. Measles is not only the most frequently fatal of the childhood viral illnesses, it is extremely contagious.

Statistical estimates of how many people in a community need to be vaccinated to achieve herd immunity from Measles range from 92-95%.

With the elimination of Measles we have lost some of our collective memory of it’s impact while the potential hazards of vaccination seem larger than they are. Happily, there is overwhelming evidence that vaccination is safe and effective. Even in the US, where many illnesses have been reduced or eliminated thorough widespread vaccination, individuals are roughly 1000 times more likely to suffer a significant complication from a vaccine preventable illness than suffer significant harm from the vaccine itself.

Help keep everyone, and especially yourself healthy, get vaccinated! If you have any questions or concerns about measles or other vaccines, or need an appointment to get immunized, please contact our office. We would love to help!

The Fraser Medical Clinic is committed to providing the best possible preventative care for our patients. This requires careful attention to evolving guidelines regarding best practices.

I would like to take a moment to explore the recently published United States Preventative Services Task Force or USPSTF recommendations regarding genetic testing for breast cancer risk.

Medical testing is now available for the BRCA 1 and BRCA2 genes. If one or both of these genes is defective a woman’s estimated lifetime risk of breast cancer increases from an average of 12.5% in the unaffected population to a range of 45-65%. With defective BRCA genetics ovarian cancer risk increases from a lifetime average of 1.4% to 10-35%. Women who are identified as high risk can benefit from options such as more frequent or technologically advanced cancer screening, risk reducing medications, and risk reducing surgery.

The newly published guidelines states that women who have family members with cancer of the breast, ovaries, fallopian tubes, lining of the pelvis or abdomen, or any BRCA-genetic related cancer should use a risk assessment questionnaire, and women with positive screening risk questionnaires should be offered genetic counseling. The USPSTF does not recommend genetic testing for women with average breast cancer risk.

There are 5 acceptable versions of a risk assessment interview. These are the Ontario Family History Assessment Tool, the Manchester Scoring System, the Referral Screening Tool, the Pedigree Assessment Tool (PAT) and the FHS-7 Tool. Of these, the FHS-7 is the easiest to use, as a single yes answer to any of these questions is an indication for genetic testing.